Background Studies show that by 3 months, over half of US infants receive formula, and guidelines play a key role in formula feeding. The question then is, what might happen if caregivers follow guidelines and, more specifically, are there situations where following guidelines can result in infants who are overweight/have obesity? Methods We used our “Virtual Infant” agent-based model representing infant–caregiver pairs that allowed caregivers to feed infants each day according to guidelines put forth by Johns Hopkins Medicine (JHM), Children’s Hospital of Philadelphia (CHOP), Children’s Hospital of the King’s Daughters (CHKD), and Women, Infants, and Children (WIC). The model simulated the resulting development of the infants from birth to 6 months. The two sets of guidelines vary in their recommendations, and do not provide studies that support amounts at given ages. Results Simulations identified several scenarios where caregivers followed JHM/CHOP/CHKD and WIC guidelines, but infants still became overweight/with obesity by 6 months. For JHM/CHOP/CHKD guidelines, this occurred even when caregivers adjusted feeding based on infant’s weight. For WIC guidelines, when caregivers adjusted formula amounts, infants maintained healthy weight. Conclusions WIC guidelines may be a good starting point for caregivers who adjust as their infant grows, but the minimum amounts for JHM/CHKD/CHOP recommendations may be too high. IMPACT Our virtual infant simulation study answers the question: can caregivers follow current formula-feeding guidelines and still end up with an infant who is overweight or has obesity? Our study identified several situations in which unhealthy weight gain and/or weight loss could result from following established formula-feeding recommendations. Our study also suggests that the minimum recommended amount of daily formula feeding should be lower for JHM/CHOP/CHKD guidelines to give caregivers more flexibility in adjusting daily feeding levels in response to infant weight. WIC guidelines may be a good starting point for caregivers who adjust as their infant grows. In order to understand how to adjust guidelines, we can use computational simulation models, which serve as “virtual laboratories” to help overcome the logistical and ethical issues of clinical trials.

中文翻译：

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遵循配方奶喂养建议是否仍会导致婴儿超重或肥胖？

背景研究表明，到 3 个月时，超过一半的美国婴儿接受配方奶，而指南在配方奶喂养中发挥着关键作用。那么问题是，如果护理人员遵循指南，可能会发生什么，更具体地说，在某些情况下，遵循指南是否会导致婴儿超重/肥胖？方法 我们使用基于“虚拟婴儿”代理的模型来代表婴儿-看护者对，允许看护者根据约翰·霍普金斯医学院 (JHM)、费城儿童医院 (CHOP)、美国儿童医院 (CHOP) 提出的指南每天喂养婴儿。国王的女儿们 (CHKD) 和妇女、婴儿和儿童 (WIC)。该模型模拟了婴儿从出生到 6 个月的发育过程。这两套指南的建议有所不同，并且没有提供支持特定年龄的金额的研究。结果 模拟确定了护理人员遵循 JHM/CHOP/CHKD 和 WIC 指南的几种情况，但婴儿在 6 个月时仍然超重/肥胖。根据 JHM/CHOP/CHKD 指南，即使护理人员根据婴儿体重调整喂养，也会发生这种情况。根据 WIC 指南，当护理人员调整配方奶粉量时，婴儿可以保持健康的体重。结论 对于随婴儿成长进行调整的护理人员来说，WIC 指南可能是一个很好的起点，但 JHM/CHKD/CHOP 建议的最低剂量可能太高。影响 我们的虚拟婴儿模拟研究回答了这个问题：护理人员是否可以在遵循当前的配方奶喂养指南的情况下，得到一个超重或肥胖的婴儿？我们的研究发现了几种可能因遵循既定的配方奶喂养建议而导致不健康的体重增加和/或体重减轻的情况。我们的研究还表明，JHM/CHOP/CHKD 指南中每日配方奶喂养的最低建议量应较低，以便护理人员能够更灵活地根据婴儿体重调整每日喂养水平。对于随婴儿成长进行调整的护理人员来说，WIC 指南可能是一个很好的起点。为了了解如何调整指南，我们可以使用计算模拟模型，作为“虚拟实验室”来帮助克服临床试验的后勤和伦理问题。